MERS May Be Mutating As The Second Case Arrives In The USA: TWO Florida Heath Workers Infected After Contact With Returning Traveller

Two Florida healthcare workers who came in contact with a confirmed Mers case are being tested for the virus after beginning to show flu-like symptoms.

Officials at Dr P Phillips Hospital said one worker is in the hospital and the second is being isolated in his home.

White House spokesman Jay Carney said: “The president has been briefed on this development. The CDC [US Centers for Disease Control and Prevention] is taking the current situation very seriously and is working in close coordination with local health authorities.”

Five healthcare workers from the regional medical centre and another 15 from the Dr P Phillips Hospital are being tested for Mers, including the two who have developed symptoms.

Hospital officials said they are awaiting test results to confirm any secondary infections. (BBC)

When MERS-CoV first appeared in September 2012 the patients found to be suffering from it all had co-morbidities: They were all suffering from some other disease or condition that had weakened their immune system making them more prone to infection. Almost exclusively these people had been in close contact with camels, or people who work with or are otherwise around camels.

We were told that person to person spread was highly unlikely in healthy individuals.

Of late, more patients are appearing who do not have any co-morbidities, they are fit healthy people, often working in the health profession. Take the following cases reported by the World Health Organization on May 7th:

The following details were provided to WHO on 3 May 2014 by the IHR National Focal Point for Jordan:

A 28 year-old male health-care worker complained of a headache and sore throat on 22 April 2014. On 26 April 2014, chest X-rays showed normal findings and testing performed on 27 April 2014 were negative for MERS-CoV. On 30 April 2014, he developed a cough and fever and was admitted to hospital in Zarka on the same day. On 2 May 2014, a chest X-ray showed pneumonia and tested positive for MERS-CoV. The patient is currently in a stable condition.

He is reported to have had close contact with a previously reported case who was also hospitalized in Zarka.

The following details were provided to WHO on 6 May 2014 by the IHR National Focal Point for Jordan:

A 56 year-old Jordanian male resident of Zarka and respiratory therapist at a private clinic was admitted to hospital on 28 April 2014 with pneumonia. On 3 May 2014, he developed acute respiratory distress syndrome and was transferred to the intensive-care unit. Throat swab specimens were collected on 4 May 2014 and tested positive for MERS-CoV on 5 May 2014. The patient died on 5 May 2014.

The thing to note here is the last line of the WHO report:

He did not have a recent travel history or exposure to a known laboratory-confirmed case of MERS-CoV.

As a respiratory therapist it is very possible he came into contact with a MERS case, albeit an unknown one, during the course of his work. Equally as a respiratory therapist he would have been well versed in cross-infection and universal precautions, particularly as there were known MERS cases in the area. Bearing all this in mind he caught it and he died from it.

Assuming that he took the required precautions one has to question if MERS-CoV has mutated and is easier to catch from airborne droplets than it was before, through mutation.

The worry is that mutation goes through stages that can ultimately make a less common virus, such as MERS, combine with a common virus, such as the common cold or influenza.

The second ‘imported’ case of MERS in the United States is a cause for concern, but not yet for panic. MERS is a coronavirus:

Coronaviruses are named for the crown-like spikes on their surface. They are common viruses that most people get in their lifetime. These viruses usually cause mild to moderate upper-respiratory tract illnesses.

Coronaviruses may also infect animals. Most of these coronaviruses usually infect only one animal species or, at most, a small number of closely related species. However, SARS coronavirus can infect people and animals, including monkeys, Himalayan palm civets, raccoon dogs, cats, dogs, and rodents. (source)

Although at this point neither the CDC or the WHO is recommending people change their travel plans the situation is very fluid, and when a disease kills as much as 30% of the people who contract it, there is a need for ongoing vigilance. There is often a gap of a couple of days between a person first feeling vaguely unwell, and testing negative for MERS, and feeling grossly unwell and testing positive. So far The West seems to have dodged the bullet, with those travelling through and into the United States and Europe not being contagious. The law of averages says this will not always be the case, at some point a contagious person is going to be travelling on an aircraft with several hundred other people sharing the same air.

At that point the possibility of a real heath emergency will be upon us.

Take Care

Liz

Lizzie Bennett retired from her job as a senior operating department practitioner in the UK earlier this year. Her field was trauma and accident and emergency and she has served on major catastrophe teams around the UK. Lizzie publishes Underground Medic on the topic of preparedness.

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